What the heck is wrong with eHealth project management?

By Dominic Covvey

A few years ago, I participated in a major portal development. That portal addressed patient care, but was beset by significant problems.

One of these was the failure to include an expert who understood the nature of the patients who would be affected by the portal. When an expert was engaged rather late in the project, she pointed out that many of the targeted patients were depressed and unlikely to use the portal.

Another issue was that the software development team did not use adaptive or agile development techniques – even though this was a highly innovative project. They did proclaim that the agile approach was important, but their contract did not allow them to proceed using that development methodology.

Further, the people who conceived the project failed to consider that this was quite an innovative exercise and there was little or no opportunity to readjust activities in response to what was discovered as the project proceeded. Finally, there was an expectation that the project would also evaluate the effectiveness of the system, but it was not realized that this would require several years of use, which was not funded.

In other instances, I have been subjected to what I will call ‘amateur project management’, by less-than-fully mature project leaders, who seemed to be guided by a textbook.

I will admit that I do not know the answers, but here are some of the questions you might want to answer:

Are we using the wrong project management paradigm, one suited more for well-understood, cut-and-dried and many-times-repeated projects, versus a paradigm that can address the management of innovation? Most eHealth projects have a significant innovation dimension.

Given the clear message that agile development is the wave of the future and that the ‘waterfall method’ is dead for anything but the simplest development, why do we not yet have ‘agile project management’?

Do we have the community of mature, experienced and capable eHealth project managers that we need? Are our education and training programs producing this kind of project manager?

Is the object of project management just to get projects done on time and within budget, or is it also to deliver an effective project? In other words, is it only these quantity outcomes that are important, or are quality outcomes also crucial?

What are the crucial competencies that project managers must master before they are given serious projects? In particular, should there be a ‘ladder’ that a project manager must climb in terms of experience: starting as an observer, then as a participant, then as an apprentice, then as a co-leader in a small project and then in increasingly larger and more complex projects? Should a PMP or similar certification be an absolute minimum requirement?

Is there a set of attitudes project managers must have, including truly understanding the goals and objectives and the quality of crucial deliverables? What attitudes should the project manager have related to the handling of people?

What are the agreed responsibilities and authorities of a project manager? What if a major issue is discovered, like lack of clinical expertise on the project team, but the powers-that-be want the project to continue? Think, in this case, of the way management browbeat engineers into continuing with the launch of the Challenger space shuttle. That made NASA have the meaning ‘Need Another Seven Astronauts’!

Dominic Covvey is President, National Institutes of Health Informatics, and an Adjunct Professor at the University of Waterloo.

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